High Yield factoids and Clinical Situations Flashcards Preview

Measurement of 17-hydroxyprogesterone is the preferred diagnostic technique in patients with congentical adrenal hyperplasia. 17-hydroxyprogesterone is a steroid precursor that builds up in______ deficiency.

21-hydroxylase

2

Tumors in this area typically present with headaches, symptoms of pituitary dysfunction secondary to compression of the healthy pituitary tissue by the mass including decreased linear growth velocity and diabetes insipidus, and visual field disturbances, classically a bitemporal hemianopsia. SEen in children

cranipharyngiomas

3

Viruses are the most common cause of gastroenteritis in young children. The most common cause of viral gastroenteritis is_______, although the incidence has decreased with the advent of vaccinations. infection occurs most frequently in children aged 3-15 months. NONbloody diarrhea

rotavirus

4

most common during the first two year of life. The cause is often unknown. It presents with the abrupt onset of colicky abdominal pain, knee flexing, emesis, and bright red blood per rectum. On exam, it is sometimes possible to palpate a sausage-shaped mass in the right upper quadrant.

intussusepction; get abdominal CT if you suspect!!

5

what do you do to reduce intussuseption in a kid?

air-contrast barium enema

6

is the best test for diagnosing PSC. The exam shows a characteristic beaded appearance that is caused by segments of duct fibrosis that alternate with areas of dilation.

Endoscopic retrograde cholangiopancreatography

7

presents insidiously with non-specific symptoms such as fatigue, pruritus, abdominal pain, fever, weight loss, and intermittent jaundice. Physical exam can show scleral icterus, jaundice, and hepatomegaly. Laboratory evaluations are notable for an elevated alkaline phosphatase, direct and total bilirubin, and gamma globulin. Transaminases are normal or mildly elevated.

PSC

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exam shows a characteristic beaded appearance that is caused by segments of duct fibrosis that alternate with areas of dilation.

PSC

9

A two-year-old boy presents to your clinic with one week of blood in his stools. The child is otherwise well. He has not have any fevers, anorexia, emesis, abdominal pain, diarrhea, constipation, hematuria, gingival bleeding or rash. He has no significant medical history and is growing and developing normally. On physical exam, he is afebrile with normal vital signs. He is well-appearing, conjunctivae are rosy, there is no heart murmur, abdomen is soft, non-tender, non-distended, and there are no anal fissures. What test, what do you expect?

Tc-99m pertechnetate is taken up by the gastric mucosa. It is non-invasive and involves minimal radiation: Meckels2

What are the signs of Fe poisoning? What is the mechanism of cell death leading to Iron poisoning?

Patient exhibits signs of foot drop. The disease is caused by decreased nerve conduction velocity, in this case on the common peroneal nerve... What is the disease and what is the mutation? What will the individual look like as the disease progresses

Charcot-Marie-Tooth: mutation of genes responsible for myelin synthesisLater develops and see stork legs, and see weakness in hands and feet later. High arches

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65 yo woman is admitted to the hospital for dysnea and fatigue. She has a history of heart fail exacerbations, hypercholesterolemia, and 36 pack year smoking history. Her exam shows tachycardia, distended neck veins and bilateral crackels. Therapy is started and labs show her hematocrit went from 44% to 50%. She has normal red blood cell mass and PaCO2 is 70 mmHG. What is the cause of pts polycythemia?

Relative ErythrocytosisPolycythemia in female >48% and in male >52%. You need to look at RBC mass. If its increased, then it's either Poly-Vera in which case you would see elevation in all three cell lines or Secondary Erythrocytosis from EPO tumor. Relative is when you ahve high Hct and normal RBC mass. Causes are volume depletion from diuresis (duh, you gave her a loop to tx heart fail) or dehydration

34

What medication would you give for pt that has a horrible headache behind his right eye, sees halos in vision field and feels nauseous. What 's the MOA

Pt has acute closed angle glaucoma. Give pt Acetazolamide= carbonic anhydrase inhibitor thus blocks NaHCO3 and water resorption in proximal tubule of the proximal tubule. In the eye, carbonic anhydrase modulates HCO3 formation in aqueous humor. End up with urinary bicarb wasting and get alkaline urine

35

What is the best way to initially help out individual with hypoglycemia from DM?

TNF-alpha

41

Brown pigment stones in the gall bladder are usually caused by what?

Arise secondary to infection of biliary tractthis results in release of B-glucuronidase by hepatocytes and bacteria--> causes hydrolysis of bilirubin glucoronides and increased unconjugated bilirubin in bile

42

What cytokines are key in mediating systemic inflammatory response ant stimulates hepatic secreation of acute-phase proteins like fibrinogen. High levels of fibrinogen increase the ESR (nonspecific marker of inflammation)

IL-1, IL-6, and TNF-Alpha

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Metabolite of AA and fnx to stimulate neutrophil migration to site of inflammation

MHC class I--> causes apoptosis of presenting cell

What presents bacterial antigens that are phagocytosed and digested to Thelper cells and what does this result in?

Pt is getting worked up for peripheral edema. She isn't on meds and has no other medical history. Urinalysis shows protein in her urine and serum contains IgG4 antiB to phospholipase A2 (PLA2R) Whats the Dx

Phospholipase A2 IgG antiB are indicative of membranous nephropathy

49

What drug is a neuramidase inhibitors there-by decreasing release of virion particles?What disease does it tx and prevent?

Oseltamivirtx Influenza A and B

50

Inability of B lypmhocytes to undergo isotype switching. You see lymphoid hyperplasia and recurrent sinopulmonary infections. Often d/t absence of CD-40 ligand on T lymphocytes from genetic deficiency in enZ reponsible for DNA modification. What is the Diseaes?

Drug of choice for pts with diabetes and HTN?

ACE inhibitors

Drug of choice for pts with HTN and have evidence of CAD and CHF

Beta blockers

First line tx for patients with essential hypertension

Hydralazine

These work by inhibiting the Na/Cl co transporter in the distal convoluted tubule thereby reducing peripheral vascular resistance to tx HTN. How does the body respond to this?

Thiazide diuretics--> body will respond to low intravascular volume by releasing aldosterone--> this will decrease reabsorption of potassium and hydrogen ions

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1.Primary pigment found w/in bile from hemoglobin but lacking in iron2. Insoluble yellow-brown pigment with lipids and phospholipds complexed to proteins and associated with wear and tear3. brown black pigment formed in melanocytes when tyrosine is oxidized to form dihydroxyphenylalanine4. protein is pink-red extracellular substance that can accumulate and cause damage by placcing pressure on adjacent cells

1 . Bile2. lipofuscin3. Melanin4. AMyloid

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What are the structures from the Dorsal pancreatic bud?What about the Ventral pancreatic bud?

Dorsal = Body, tail and most of the head and the small accessory ductVentral = Uncinate, inf/posteror part of head adn the Major pancreatic duct

ssDNA virus transmited by respiratory route. What diseases does it cause?What do we worry about in Sickel Cell pts?

What do you prescribe for individual with RA for acute relief of symptoms?What about long term?

Acute = glucocorticoidsLong term = Methotrexate

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A man recently recieved a kidney transplant. His T-lymphocytes quickly recognize the foreign HLA molecules from transplant renal cells. Inhibition of which substance would specifically reduce the proliferation and differentiation of these T lymphocytes?How?What meds would do this?

Calcineurin= phosphatase that is activated when stimulaiton of appropriate cell receptor occurs. Calcineurin then phosphorylates NFAT which allows it to enter the nucleas and bind IL-2 promoter. IL-2 stims growth + dif of T cellsCyclosporine and TAcrolimus inhibit calcinuerin acitvation

67

3 yo presents to office with FTT, ataxia and can't see in the dark. Mom says he has oily, fatty looking stools. You notice dark pigmented skin in his armpit area and the crease of his neck. What is the dx?

Abetalipoproteinemia: decreased synthesis of apolipoprotein B--> inability to make chylomicrons--> decreased secreation of cholesterol and see VLDL in blood and fat accumulation in enterocytes

Lab worker comes in with rapid onset breathing difficulty, palpitations and flushed skin. You find out he works in a lab and likely has accidental poisoning. You administer amyl nitrate. What was the poisoning and why does this work?

Cyanide poisoningCyanide binds to cytochrome a3 which is key in ECT thus inhibits aerobic metabolism. Nitrates take hemoglobin from Fe2+ to Fe3+ state or methemoglobinMethhemoglobin binds tight to cyanide and sequesters it from ETC

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measure of potency of inhaled anesthetic. Its the minimal conc of the anesthetic in the alveoli that renders 50% of pts unresponsive to painful stimuli